Raedwoon

This study assessed the Raedwoon program, a 25-day nursing leadership course, using a quasi-experimental design. It found overall improvements in leadership and nursing competencies, except in the “Inspire a Shared Vision” practice and documentation skills.


Raedwoon: A leadership development program for direct care nurses in Saudi Arabia
By Nashi Masnad Alreshidi, PhD, RN; Afaf Mufadhi Alrimali, MSc, RN; Wadida Darwish Alshammari, MSN, RN; Kristine Angeles Gonzales, BSN, RN; Salwa Thamer Alrashidi, MHSM, RN; Fe Baltazar Gaspar, BSN, RN; and Amal Msaid Alrashidi, BSN, RN N urses are widely recognized as the cornerstone of healthcare ecosystems, tasked with overcoming the complex challenges of their profession under the guidance of skilled leaders.2][3][4] However, the healthcare sector faces significant challenges due to a shortage of nurse leaders and an increasing trend of nurse managers leaving their positions. 5In addition, the proportion of nurses expressing a lack of interest in leadership roles and a perceived unpreparedness to take on such positions is accelerating notably. 6Variables linked to diminished interest in leadership roles among nurses included a lack of readiness for leadership and insufficient preparation. 7hese issues primarily affect the retention and recruitment of qualified nurses who can assume and excel in these vital leadership roles. 3,8his situation has prompted the creation of targeted educational programs aimed at enhancing nurses' leadership abilities.Such programs can cultivate nurses' leadership qualities and pave the way for career growth, empowering nurses to assume crucial leadership positions and make policy decisions that influence the course of healthcare delivery. 1,9The lack of nursing leadership and the shortage of reliable workforce data in recent years have stunted the growth of the nursing field in Saudia Arabia, causing it to lag behind international nursing advancements. 10This gap highlights the urgent need for leadership education research, which seeks to address these shortcomings by nurturing leadership skills within the Saudi Arabian nursing community and promoting alignment with global nursing standards and practices.

The Raedwoon leadership educational program
The Raedwoon Program is specifically developed to align with the unique requirements of the local healthcare system.Initiated by the Nursing Executive Administration within Hail Health Cluster, which is the entity responsible for providing healthcare services in Hail region, Saudi Arabia, its primary objective is to bolster nursing services by identifying and developing leadership potential.The program derives its name from the Arabic term for "leaders," reflecting its focus on nurturing a cadre of nurse leaders capable of adeptly managing the demands of contemporary healthcare.Educational initiatives rooted in established theoretical models and tailored to the specific contexts of their organizations are reported to be effective in developing nursing leadership. 1 Therefore, the Raedwoon Program integrates the "Five Practices of Exemplary Leadership" conceptualized by James Kouzes and Barry Posner, adapting its principles to the nursing context. 11The program is focused on cultivating the knowledge, skills, and essential competencies of emerging leaders, thereby fostering a reservoir of skilled individuals for nursing leadership positions.This aligns with the Hail Health Cluster's strategic objective to "develop leadership and talent," as part of the strategic theme to "build the foundations and capabilities of the future." Spanning 25 days, the Raedwoon Program offers a comprehensive and multifaceted curriculum designed to enhance nursing leadership, including interactive group exercises such as case studies, role-playing scenarios, and simulation exercises that foster collaborative learning and problem-solving skills.The program covers a broad spectrum of topics including advanced nursing practices, healthcare policy, leadership ethics, communication strategies, accreditation standards, and change management in healthcare settings.A strong emphasis is placed on developing skills such as emotional intelligence, conflict resolution, team building, and motivation.Integral to the curriculum is the development of core competencies in nursing, with a particular focus on clinical judgment, patient safety, and evidence-based practice, ensuring that participants are not only leaders but also highly competent practitioners.
Key to the program is the hands-on education in both administrative and clinical settings.Administrative education encompasses healthcare administration, resource management, and team leadership, whereas clinical education focuses on patient-care management, clinical decision-making, and emergency response strategies.A distinctive feature is the practical observation phase under the mentorship of seasoned nurse leaders such as the director of nursing, nursing supervisor, nursing quality management supervisor, continuing nursing education supervisor, and head nurses (nurse managers).This phase provides shadowing experiences and personalized coaching sessions, offering insights into various nursing roles and leadership styles.Participants are also encouraged to undertake a capstone project to apply their learned knowledge and skills by identifying and addressing real-world challenges in their work environments.
The Raedwoon Program incorporates Kouzes and Posner's five practices of exemplary leadership in various practical and engaging ways: 1. Model the Way: Participants engage in self-reflection exercises and develop personal www.nursingmanagement.comleadership philosophy statements, which help them identify and solidify their values and beliefs.These activities are complemented by shadowing experienced nurse leaders during the practical observation phase, during which they witness firsthand how values and principles are embodied in daily leadership practices.
2. Inspire a Shared Vision: Through workshops focused on communication, participants learn to develop and articulate a compelling vision for their teams.They practice crafting and delivering inspirational messages, using case studies that involve creating a vision for change or improvement in healthcare settings.

Challenge the Process:
The curriculum includes problemsolving workshops in which participants analyze case studies involving complex healthcare scenarios.They're encouraged to think critically and propose innovative solutions, thereby challenging existing norms and practices in healthcare.
4. Enable Others to Act: Group exercises and role-playing scenarios are used to simulate team management situations.Participants practice delegation, empowering team members, and fostering collaboration.They also receive education in conflict resolution, learning to navigate and resolve interpersonal challenges within a team.

Encourage the Heart:
The program incorporates sessions on recognizing and valuing the contributions of team members.Participants engage in activities that focus on building team morale and showing appreciation, such as learning how to give effective, positive feedback and celebrating small wins in team projects.
Each element of the program is crafted to provide practical, real-world applications, ensuring that graduates are well-equipped to lead effectively and empathetically in the nursing field.

Purpose of the study
The scarcity of research on leadership program development within Saudi Arabia underscores the urgent need for scholarly investigation into this field.This article presents a study that assesses the impact of the Raedwoon Program on the enhancement of leadership skills and professional nursing practices.This study goes beyond merely identifying the presence of leadership skills, delving into the evaluation of nursing competencies to ensure that nurses not only have the skills to lead but also adhere to professional standards and guidelines, are prepared to manage effective teams, and contribute positively to patient outcomes.By examining the experiences of 29 RNs who participated in the program, this study aims to expand the body of knowledge on nursing leadership development, and by doing so, it directly responds to the highlighted gap in the literature.

Study design
A quasi-experimental design was employed to evaluate the effectiveness of the Raedwoon Program, with a single group undergoing pre-and posttest.The institutional review board at Hail Region approved the study: approval number (2023-57).

Sample and setting
The investigators recruited participants for the Raedwoon Program from all 16 public hospitals within Hail Health Cluster.They determined the sample size of 29 nurses based on factors such as the expected effect size, standard deviation, and a standard alpha level of 0.05.These 29 nurses represented the entire Raedwoon Program class and 100% of eligible nurses within the recruitment period.All participants completed both the pre-and posttests, enabling a consistent and comprehensive assessment of the program's impact on their leadership development.To be

The scarcity of research on leadership program development within Saudi Arabia
o evaluate the nurses' competence, the short version of the NPC Scale was utilized.Originating in Sweden, the comprehensive NPC Scale includes 88 questions distributed across eight competence areas (CAs), as described by Nilsson and colleagues. 13The NPC Scale Short Form (NPC-SF) was created in 2018, and it consists of 35 items measuring six CAs using a 4-point Likert-type scale, ranging from 1 (to a very low degree) to 4 (to a very high degree). 14urses are also given a "can't decide" response option.The six areas of competence assessed by the scale are: Nursing Care; Value-Based Nursing Care; Medical and Technical Care; Care Pedagogy; Documentation and Administration of Nursing Care; and Development, Leadership, and Organization of Nursing Care.The reliability of the NPC-SF is deemed acceptable, with Cronbach alpha values ranging between 0.71 and 0.86. 14,15

Data analysis
The collected data were compiled and transferred into a Microsoft Excel spreadsheet for analysis.Then they were cleaned, recoded, and analyzed using IBM SPSS version 29.0.Descriptive statistics were produced.Continuous variables were expressed as means ± standard deviation.Independent samples t tests and analysis of variance (ANOVA) were used to compare the means of the continuous variables against those of the nominal variables.Paired sample t tests were employed to analyze the discrepancies in the data between the pre-and posttest results.Data normality was assessed, and the assumptions were satisfied.All analyses were calculated with a 95% confidence interval and considered statistically significant at P < .05.

Results
A total of 29 responses were analyzed.Participants' personal and professional characteristics varied (see Table 1).Most participants were female (65.5%), and the predominant age group was 20 to 29 (62.1%).With respect to education, a significant majority held a bachelor's degree (93.1%).Experience levels were mainly between 3 and 5 years (51.7%), and staff nurses comprised the largest group (48.3%).The most common work setting was non-ICU (37.9%).Table 2 shows the mean, median, and standard deviation of the five leadership practices generated from the LPI questionnaire and the six constructs from the NPC Scale.
Concerning the LPI, the top leadership practices reported by the respondents, at more than 70%, were Challenge the Process, Model the Way, Encourage the Heart, and Enable Others to When comparing the demographic characteristics related to the five leadership practices, there were no statistically signif-icant differences based on participants' education, experience, title, or unit of practice.There were, however, differences by gender and age.Females scored higher than males in the Inspire, Challenge, and Encourage practices.Those in the youngest age group scored higher than the others in the Inspire, Enable, and Encourage practices (see Table 3).Related to the NPC Scale, there were also no statistically significant differences based on the participants' education, experience, title, or unit of practice.Females scored higher in every construct of the NPC Scale, except Nursing Care, which wasn't a statistically significantly difference.The scores in Value-Based Nursing Care also differed by age, with scores descending with increasing age.Nursing Care was also statistically different based on the unit of practice, with those working in the ICU having the highest scores (see Table 3).
From the pre-to posttest, there were significant changes in LPI scores among the five leadership practices; P < .05.All practice scores increased  4).
In the follow-up phase of the evaluation, the investigators collected data on the current professional roles of the participants to assess career advancement after program completion.The findings revealed that the professional roles within the cohort were quite diverse, reflecting significant career progression.A noteworthy 24.14% of participants had advanced to the position of charge nurse, while 17.24% had achieved the head nurse role, and 6.90% had been promoted to director of nursing roles.Additionally, participants had attained the posi-tions of supervisor and program deputy director.

Discussion
The study revealed an upward trend in both LPI and NPC scores from the pretest to the posttest, highlighting the intervention's overall effectiveness.Interestingly, there was a marked decrease in the Inspire a Shared Vision practice on the LPI postprogram.The most prominent leadership practices were Challenge the Process, Model the Way, Encourage the Heart, and Enable Others to Act, with a particular emphasis on Encourage the Heart.In terms of the NPC Scale, the highest scores were recorded in Value-Based Nursing Care and Care Pedagogics, whereas the lowest scores centered around Documentation and Administration of Nursing Care.Demographically, gender and age showed significant variations in both the LPI and NPC Scale, with females outscoring males in several areas and younger respondents displaying a propensity toward certain leadership practices.
The pre/posttest evaluations provide significant insights into the evolution of leadership practices.It's noteworthy that all leadership practices, except Inspire a Shared Vision, witnessed an upswing.This implies that by the end of the program, the participants were potentially more attuned to and capable of executing recognized leadership actions.Contrary to our observations, most past studies have reported improvements across all five LPI subscales.
For instance, Leggat and colleagues observed considerable growth in all LPI subscales among Australian nurses whose training emphasized inquirybased learning, combining simulations, online modules, and workshops. 16In the US, Bhalla and colleagues noted an overall increase in LPI subscale scores among participants of 90-minute seminars based on the Nursing Leadership Institute Competency Model. 17However, Spencer and colleagues, whose Association Development and Professional Transformation workshop blended transformational leadership with Kouzes and Posner's 2012 Leadership Challenge framework, reported changes in LPI subscales that weren't statistically significant. 18On the other hand, Fitzpatrick and colleagues highlighted that significant enhancements in leadership practices among American nurses were sustained 3 months after the program.The focus of Fitzpatrick and colleagues' study was on refining nurses' clinical leadership skills, such as personal awareness and change management, although the precise educational framework wasn't specified.Each program, distinct in its structure and emphasis, offers unique perspectives on leadership development among nurses, as evidenced through LPI assessments.
The results derived from the LPI highlight the respondents' strong inclination toward certain leadership practices, specifically Challenge the Process, Model the Way, Encourage the Heart, and Enable Others to Act, with a particular emphasis on the practices of Encourage the Heart.From this, it can be inferred that these nurses foster an environment in which innovation is cherished, setting an example becomes integral, and ensuring continuous motivation becomes a cornerstone of their leadership style.These observations counter studies conducted in Brazil and the US, where participants displayed proficiency in all five leadership tenets. 20,21However, what stands out in those studies is the pronounced emphasis on the practice of Enabling Others to Act, underscoring the priority that leaders place on empowering team members and reinforcing the universal importance of collaborative work environments.
In this study, the notable decline in Inspire a Shared Vision merits deeper investigation.This drop could stem from the intervention's design or content, which may lack emphasis on this leadership aspect.Alternatively, participants' evolving understanding postintervention might have made them more self-critical about their ability to inspire a shared vision.Their perceptions may have shifted, leading them to deem other leadership practices more vital.External organizational factors could also influence this change.
Further qualitative analysis and participant feedback are needed to discern the exact cause.
The pre-to posttest evaluations revealed a significant increase across all NPC Scale items, indicating that the intervention was predominantly effective in enhancing nursing competence.This positive trend aligns with findings from Høegh-Larsen and colleagues who observed similar improvements among nursing students in Norway. 22Notably, our results emphasize nurses' self-perceived competence in Value-Based Nursing Care and Care Pedagogics.This underscores the inherent emphasis nurses place on the ethical and educational dimensions of their roles.[24][25] However, in a divergent trend, nurses in Saudi Arabia recorded lower competencies in Care Pedagogics, while both Saudi and European nurses perceived Development, Leadership, and Organization of Nursing Care as areas of lesser proficiency. 15,22,25his could be attributed to the multifaceted nature of those competencies, as they require not only clinical expertise but also organizational skills, leadership abilities, and a deep understanding of healthcare systems.
Meanwhile, our findings pinpoint a potential weak link in the chain: Documentation and Administration of Nursing Care.Despite being pivotal to patient-care continuity and interprofessional communication, this area was perceived as a lesser competency.One potential rationale might be that the growing administrative requirements in healthcare are diverting nurses' attention from their core care duties.Alternatively, it might suggest a need for more comprehensive educational modules on these tasks, perhaps calling for systemlevel interventions to simplify and streamline administrative processes, thus reducing the perceived burden on the nursing cadre.
The demographic comparisons present interesting insights.The absence of any statistically significant variance across parameters such as education, experience, title, or unit of practice with Our findings pinpoint that Documentation and Administration of Nursing Care is a potential weak link in the chain.www.nursingmanagement.comregards to the LPI and NPC signifies that these factors might not necessarily dictate leadership practices or the perception of professional competencies.Gender and age, however, introduced pronounced differences.For instance, females showed a higher propensity to the Inspire, Challenge, and Encourage practices, which aligns with the literature suggesting that women often adopt transformational leadership styles, characterized by inspiration and motivation. 26oreover, the trend whereby younger respondents scored higher in the Inspire, Enable, and Encourage practices might imply a generational shift in leadership practices, or it could be a reflection of the enthusiasm and adaptability often associated with younger professionals. 27rom the NPC perspective, females consistently outscored males in almost every construct, again highlighting potential gender-based nuances in nursing professionalism.The declining trend in Value-Based Nursing Care with increasing age is intriguing, potentially suggesting that, as professionals age, their perspectives or priorities shift.Similar findings were reported by Bjuresäter and colleagues. 25

Limitations
When interpreting the results of this quasi-experimental study, it's crucial to acknowledge the absence of a control group.This omission leaves the study vulnerable to external factors.Additionally, the study was limited to LPI self-assessments due to resource constraints, acknowledging that a 360-degree assessment may offer a more holistic evaluation of leadership practices.Furthermore, the study didn't incorporate a qualitative assessment, which would have provided deeper insights into underlying trends and participant perspectives.

Implications for nurse leaders
Nursing leadership stands at the forefront of advancing healthcare quality and fostering innovation.Effective education leadership programs are vital in nurturing these roles, with a stronger emphasis on experiential learning and mentorship.It's important to tailor these programs to address specific competency gaps, such as in documentation and administration, and to account for demographic influences on leadership styles and competencies.Leadership education shouldn't focus only on enhancing existing strengths but also on identifying and improving areas that require more attention, such as visionary leadership skills.Finally, establishing continuous professional development pathways is paramount to ensure the longevity and adaptability of leadership competencies in an evolving healthcare landscape.

Sustained leadership excellence
The comprehensive evaluation of leadership practices, underscored by the pre-to posttest evaluations, illustrates the program's efficacy.Participants have assumed a spectrum of leadership roles postprogramevidence of the program's impact on nurturing pivotal leadership skills and fostering professional growth.This outcome affirms the intervention's effectiveness, but other findings highlight specific areas requiring further scrutiny.Notably, although most nurse participants have enhanced their leadership practices, the domain of Inspiring a Shared Vision has emerged as an exception, signaling a need for more targeted analysis to refine the program's future versions.
Furthermore, we've identified a competence gap in documentation practices, potentially indicative of wider systemic challenges or educational shortcomings that merit strategic interventions.The data also reveal the significant influence of demographic variables such as gender and age on leadership styles and competencies.These demographic nuances are more pronounced in certain groups and have been shown to shape leadership perceptions.
It's essential to recognize that although continuous professional development and targeted training can meaningfully transform leadership perceptions, a comprehensive understanding of the root causes and broader implications of these changes is crucial.Such an understanding will guide the development of nuanced interventions that not only address immediate skill gaps but also foster an environment conducive to sustained leadership excellence in nursing.NM

Table 2 : Distribution of the mean values, median values, and standard deviation (SD) of the five LPI items and the six NPC Scale items Practice Mean Median SD LPI
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Table 3 : Demographic characteristics by LPI and NPC scores LPI NPC Scale
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